ACAH Membership Application

First Name (required)

Last Name (required)

Gender
---MaleFemale

Email (required)

Phone (required)

Address (required)

State (required)
---Australian Capital TerritoryNew South WalesNew ZealandNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia

Post Code (required)

Current Position Held (required)

Areas of Interest

Membership Category
---Salary more than $100,000 - $300 paSalary less than$100,000 - $150 paOverseas membership $100 paRetired membership $100 paStudents - free (evidence of current enrolment must be provided with application

AHPRA Registration Number

If not AHPRA registration, upload copy of degree for students, upload current enrolment transcript

Upload brief CV & professional statement

Please check the following:

I HAVE ATTACHED A BRIEF (1 PAGE) CV INCLUDING DETAILS OF MY CURRENT EMPLOYMENTI HAVE ATTACHED A BRIEF PROFESSIONAL STATEMENT IN RELATION TO MY WORK WITH NEWBORNS, CHILDREN AND/OR ADOLESCENTS

THE ACADEMY OF CHILD & ADOLESCENT HEALTH MAINTAINS A DIRECTORY OF MEMBERS WHICH IS AVAILABLE FOR VIEWING ONLY BY OTHER MEMBERS ON REQUEST. THIS IS A LEGAL REQUIREMENT. IN SUBMITTING AN APPLICATION YOU ARE AGREEING TO BE PLACED ON THE MEMBERSHIP ROLL. DETAILS OF ACAH PRIVACY STATEMENT & ACAH CONSTITUTION ARE AVAILABLE AT WWW.ACAH.ORG.AU CHECK THE FOLLOWING BEFORE SUBMITTING:

I CONFIRM THAT I HAVE READ THE CONSTITUTION OF THE ACADEMY OF CHILD AND ADOLESCENT HEALTH (ACAH) DATED DECEMBER 2016 AND THAT, AS A MEMBER OF ACAH, I AGREE TO BE BOUND BY THAT CONSTITUTION AND ANY OF ITS RELATED BY-LAWS WHICH MAY APPLY FROM TIME TO TIME.I UNDERSTAND THAT ACAH IS A NOT-FOR-PROFIT COMPANY LIMITED BY GUARANTEE AND THAT MY GUARANTEE IS LIMITED TO TWENTY DOLLARS (AUD $20.00).I CERTIFY THAT I MEET THE ELIGIBILITY CRITERIA FOR THE MEMBERSHIP CATEGORY APPLIED FOR ON THIS FORM AND THAT I WILL IMMEDIATELY ADVISE ACAH OF ANY CHANGE IN ELIGIBILITY.I HEREBY AUTHORISE MY NAME TO BE PLACED IN THE REGISTER OF MEMBERS.

PLEASE NOTE THAT MEMBERSHIPS WILL BE AUTOMCATICALLY RENEWED UNLESS SPECIFIED OTHERWISE.

Please enter code then click Submit